Doctor disputes opiate over-prescription claims

Purtzer, fighting to keep his license, says 'I'm very cautious and careful' in painkiller patient doses

A Southern Oregon pain management doctor at risk of losing his license for allegedly overprescribing opiates to high-risk patients said narcotics are under a larger, more critical microscope than they were 15 years ago.

A Southern Oregon pain management doctor at risk of losing his license for allegedly overprescribing opiates to high-risk patients said narcotics are under a larger, more critical microscope than they were 15 years ago.

"There were way too many opiates being prescribed, too high of dosages, patients not being monitored properly," Dr. Thomas Purtzer, formerly of the Intractable Pain Center in Medford, said of the changing attitude toward opiate prescriptions. "(Then) people started dying. We started having overdose deaths. Now the pendulum is swinging back the other way to where it's becoming Draconian."

The Oregon Medical Board last month recommended Purtzer lose his license and pay a $10,000 civil penalty for alleged gross negligence and dishonorable conduct, and for violating the federal Controlled Substances Act.

The board also alleged he failed to obtain or review the medical histories of some high-risk patients and ignored signs of drug abuse, such as requests for early refills — which he filled — and inconsistent drug screens.

Purtzer disputes several of the claims and said he was meticulous when it came to getting patient histories, follow-up appointments and dosage regulation. He said he could have done a better job with documentation and supplemental pain management therapies, such as meditation and exercise.

"I'm not free with the prescribing of opiates. I'm very cautious and careful," Purtzer said.

The Oregon Medical Board would not comment on the case or discuss whether scrutiny has increased. OMB officials did say of the 2,275 written complaints they received between 2011 and 2013, 10 percent stemmed from inappropriate prescribing cases.

Purtzer said he had been moving away from prescribing opiates because of studies that demonstrate their addictive qualities. A recent study from the National Center for Health Statistics shows drug overdose deaths in the U.S. have surpassed car accidents every year since 2008.

Locally, the majority of Jackson County's 30-or-so average annual overdose deaths are caused by prescriptions, according to the Opioid Prescribers Group, made up of more than 70 health-care professionals who are developing better ways to assess addiction risk for patients, treat chronic pain and get treatment for addicted patients.

Medical officials say this data is contrary to the philosophy from the late 1990s and early 2000s, when the importance of treating chronic pain with opiates was front and center, and the risk of becoming hooked was viewed as slim.

"We were told 15, 20 years ago that if you had legitimate pain, the chances of you becoming addicted to pain meds was almost nil," said Dr. Jim Shames, medical director for Jackson County Health and Human Services. "We were told the risks were fairly few and the benefits were great, and all of that was not true."

It also led to an abundance of prescriptions. Tom Burns, director of pharmacy programs for the Oregon Health Authority, said about 100 million opiate-based pain pills go out to patients annually in Oregon.

"That's 30 tablets for every man, woman and child. That's way too many pills," Burns said.

Purtzer said he had been warning patients of opiate dangers because of new information on their addictive nature, effects on the brain and risk of overdose and death.

In some cases, the warnings worked. Don Lambert of Central Point, a 53-year-old former patient of Purtzer's, said he had been taking high doses of opiates to alleviate pain that stemmed from surgical scar tissue pushing against a nerve. He dealt with that pain for 10 years. It had become so unmanageable that he broke several teeth from gritting them. The pain even affected his livelihood, forcing him to quit his job of selling rock-crushing equipment.

"I've been to the Mayo Clinic. I've been to all the doctors around here. I was about ready to end my life," Lambert said.

That changed during a visit to Purtzer eight months ago, he said. Since that meeting, he has reduced his pill regimen by about 75 percent, supplementing his treatment with meditation, exercise and physical therapy.

"I'm not completely off, but I'm down to taking two a day, where I was taking eight a day," Lambert said. "I'm almost pain-free right now."

Burns believes the medical community is in a transition period when it comes to the role of opiates in treating chronic pain.

"Currently there are no restrictions in place that limit the number of pills, limit the number of prescriptions. Many people are working toward that, but we haven't reached it yet," Burns said.

He said doctors and patients both need to be better educated on the dangers of prescribing opiates, and that insurance companies should be more open to paying for other treatments such as physical therapy.

"The pain is there, the problem exists, but (it's about) getting people to be more physically active, focus on function rather than elimination of pain, learning to live with their pain," Shames said. "I think that is the trend."

Whatever the endgame, medical officials say the process has to happen slowly, as hasty reforms could result in numerous withdrawal cases from already-addicted patients.

Purtzer said it's difficult to know what the exact answer is because of the psychological and emotional components involved in treating chronic pain.

"Chronic pain is definitely different than acute pain. It's much more complex. It's much more difficult to treat. Oftentimes you don't know what's causing the pain," Purtzer said. "We have a very difficult, difficult situation."

Reach reporter Ryan Pfeil at 541-776-4468 or by email at rpfeil@mailtribune.com.